Dissociative Identity Disorder (DID) was formerly known as multiple personality disorder, and remains to this day as one of the most controversial and misunderstood disorders in the Diagnostic Manual. It is a difficult diagnosis to make, and often is more difficult to treat. It has been the topic of many Hollywood productions which gives laypeople an idea that they understand what it is, but as is often the case in movies and media, there is some sensationalism that occurs. It is not a common diagnosis and is only one of the classified dissociative disorders. However, there are some patients for whom this disorder is very real and challenging, and understanding it and understanding how to address it are important in the field of mental health.
Kluft (2005) addresses the diagnostic criteria necessary in identifying this illness. He notes that in most cases, patients have been the victims of severe childhood trauma that is repetitive and prolonged. Commonly, patients also show symptoms of post-traumatic stress disorders and high levels of anxiety. Professional mental health providers have also often found that presentation of symptoms of borderline personality disorder is common. DID often begins to manifest in children who are unable to cope with the reality of persistent abuse, so they create alternative realities that protect them from having to deal with those realities. It is a protective mechanism that works well in childhood, but becomes problematic as the child ages. Individuals with this disorder have often created alternative identities that engage both internally and externally to deal with the difficult situations facing the patient.
Rifkin et al. (1998) studied DID as it presented in psychiatric hospitals. At that time, there was some thought that the diagnosis was not being made as often as it should have been and that patients were often being misdiagnosed as schizophrenic or borderline. Through this research and new methodologies for screening and diagnosis, the authors found that DID was more prevalent than had been thought, but not as high as predicted. This is a good example of the difficulty of making a sound diagnosis as it relates to this illness.
Controversy Surrounding DID
Gillig (2005) addresses the controversy of the diagnosis within the field of psychiatry. She indicates that many practitioners who treat the disorder are questioned and sometimes ridiculed for entertaining it as a true mental illness. She proposes that this stems from the discomfort many have regarding the presentation of the disorder. Some professionals in the mental health field are critical of the diagnosis as they find it too open to interpretation and confusion with other more accepted mental health problems. Many times, DID is treated only by specialists and this is also questioned in regard to whether or not clinicians are seeing something that is not there. DID is very hard for scientists to define because there seems to be no link to brain function or structure abnormality and the existence of symptoms is mostly self-reported. The bottom line of the controversy seems to be that this is a disorder that could easily be faked by a patient.
The National Institute of Mental Health (n.d.) indicates that patients with DID often first present due to amnesia or loss of time that they cannot account for and that they find distressing. This loss of time is often attributed to the existence of alternate personalities who take over for the individual for a period of time to deal with a certain situation. It is not well understood why or in what situations these alters become the dominant actor in the individual’s life. These individuals often suffer from a multitude of other diagnostic symptoms that make their lives difficult. The mechanism for developing alternate identities seems to be very dependent upon the developmental stage the child is in when they develop them. It is thought that younger children may start with “imaginary friends” who then somehow become internalized as a protective mechanism.
The Cleveland Clinic (n.d.) addresses the ways that DID is treated in patients. The first goal of treatment is to relieve symptoms and to ensure the safety of the individual. After that, psychotherapy may be effective in joining the many alters back into the one individual identity. It is a treatment process that takes a lot of intensive work due to the fact that these alternate identities are often well entrenched in the individual’s personality. Sometimes medications are used, but only to treat co-occurring conditions such as depression or anxiety. In rare cases, hypnosis is used to help patients to identify painful experiences and alternate identities.
A Fascinating, but Difficult Diagnosis
DID is a diagnosis that holds a lot of fascination in the professional psychiatric world as well as in the general population. Much of this has to do with misunderstanding about what the diagnosis means. For the patient, it can be a frustrating and frightening illness to deal with. Treatment often means revisiting painful experiences in order to evaluate them from the standpoint of an adult vs. a child. Not every patient wants to go back to those places.
Cleveland Clinic (n.d.). Dissociative identity disorder (multiple personality disorder). Retrieved from http://my.clevelandclinic.org/neurological_institute/center-for-behavorial-health/disease-conditions/hic-dissociative-identity-disorder.aspx
Kluft, R. P., M.D. (2005). Diagnosing dissociative identity disorder. Psychiatric Annals, 35(8), 633-643.
National Alliance on Mental Illness (n.d.). Dissociative identity disorder. Retrieved from http://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_Mental_Illness/By_Illness/Dissociative_Identity_Disorder.htm
Gillig, P.M. (2009). Dissociative identity disorder: A controversial diagnosis. Psychiatry, 6(3), 24-29.
Rifkin, A., Ghisalbert, D., Dimatou, S., Jin, C., & Sethi, M. (1998). Dissociative identity disorder in psychiatric inpatients. The American Journal of Psychiatry, 155(6), 844-5.